State House Dome

Garry Rayno's State House Dome: Lots of finger-pointing after Medicaid expansion defeat

By GARRY RAYNOState House Bureau

WHERE TO NOW?: After months of study, press conferences, news releases, and negotiations, lawmakers finally voted last week not to expand Medicaid eligibility and add about 49,000 low-income adults to the program that provides health insurance to children, parents, the elderly and disabled.

Over the last 10 months, much has been said about the millions of dollars that state health-care providers would lose, helping the working poor, shifting risk to private insurers and protecting taxpayers, but when the dust settled, lawmakers were where they were in June when expansion was a sticking point to settling the state budgets.

The Senate in both instances voted on party lines to kill Medicaid expansion, which is what expansion supporters had hoped to avoid the second time around.

Afterwards, there was plenty of finger-pointing and blame. Gov. Maggie Hassan and House Speaker Terie Norelli said Senate Republicans dropped the ball for the working poor, while Senate Republicans blamed Hassan for politicizing the issue.

Medicaid expansion and the related Affordable Care Act have been highly partisan issues for some time, although some states with Republican governors have approved expansion, states with large populations of uninsured poor like New Jersey, Arizona and Ohio.

But not in New Hampshire where Republican former House Speaker William O'Brien did everything in his power to prevent expansion both last year and last week during the House debate.

With the change to Democratic majority in the House in the last election, the House now backs expansion along with Hassan, but the 13-member Republican Senate majority has used its advantage to block it.

That was supposed to change with a study commission this summer and fall proposed by former Senate President Peter Bragdon who led the charge in the Senate against expansion.

When Bragdon resigned as president and Chuck Morse took over, expansion supporters were optimistic that if they could make the numbers work in the budget, the new president would not oppose them.

The study commission issued its report, which largely became the House bill, while Morse called it a good framework to begin discussions.

That is where it stood as the three sides negotiated behind closed doors.

About three weeks ago, Morse and Senate Majority Leader Jeb Bradley held an off-the-record meeting with State House reporters to outline their plan. They said the biggest sticking point with Hassan and the House was the timeline that required all newly eligible Medicaid recipients to transfer to private insurance within a year.

Between then and last Thursday, the Senate never really moved off their plan while the House and governor did make some significant concessions leaving one major issue: the timeline.

Hassan and Norelli said the change to private insurance could not be done within a year: number one, because federal officials would not approve it with Anthem Blue Cross Blue Shield the only carrier in the state exchange; and two, insurance companies need more than a year to do their due diligence to decide if they want to offer policies on the exchange. More carriers on the exchange not only is a federal requirement, it also creates competition that in theory drops the price for consumers.

The other issue is whether private insurance can be cost neutral with standard Medicaid services that pay providers 54 cents on the dollar, much less than private insurers.

But that issue never really moved front and center as Morse and the Republicans refused to budge on the one-year limit on the bridge year to private insurance, although they were willing to delay expansion until federal approval was granted.

Hassan's strategy in the 10 days leading up to the vote was to hold press conferences in the senate districts of Republicans thought to be more favorable to expansion such as Sens. Nancy Stiles of Hampton, Bob Odell of Lempster, Jeanie Forrester of Meredith and David Boutin of Hooksett.

The press conferences were intended to bring local pressure on the senators to pick them off and convince them to go along with the House's plan.

The problem with that strategy is Republican senators did not want to go against Morse on the first major issue of his presidency. The additional pressure poisoned the well and drove Republicans more tightly together.

At the same time the Libertarian wing of the Republican Party threatened Republican senators who voted for expansion with primaries next year.

All this turned up the heat prior to Thursday's session.

Posturing aside, Hassan, Norelli and Morse all said they want to continue talking to come up with a New Hampshire solution to address the poor's difficulty finding access to health care.

Given the ill will, negotiators might want to take a little time off, enjoy their turkey, and then try to hammer out a compromise that could be handled quickly once lawmakers return to Concord in January.

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BENEFITS: By all accounts, Thursday's special session was long and tedious for everyone, particularly in the House where the Republican strategy was to challenge the speaker's rulings, and anything else they could, call for reconsideration on previous votes and deal with 28 amendments that had no chance of ever passing.

O'Brien led the charge, challenging his predecessor at every turn as the House spent well over an hour on procedural maneuvering before ever taking up an amendment.

As the raucous session dragged on, several Democrats quietly lamented the fact that O'Brien would not be running again, noting, "He's the best fundraiser we've ever had."

Minutes after it became clear the Senate would not pass expansion, the Senate Democratic Caucus sent out a fund-raising email asking for support.

The letter charged that Senate Republicans turned their backs on tens of thousands of New Hampshire families. "We came so close in 2012 - out of 711,000 votes cast across the state, we were only 611 votes short of Democrats regaining the majority. Let's fight back and put an end to the senseless Koch Brothers fueled Tea Party obstruction. Help us today with a contribution so we can finish the job in 2014 and take back the Senate," the letter read.

And finally, all lawmakers benefited from the special session. Each earned $3 for attending and they received mileage payments.

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UP THE ANTE: Much of the sales pitch last session for approving Senate Bill 152, to allow one casino along the state's southern border, was Massachusetts had approved casino gambling and was a breath away from opening casinos on our doorstep, taking New Hampshire's revenue and sending back problem gamblers.

So far the push for casino gambling in the Bay State has hit a few road blocks, mostly from communities that said through the ballot box they don't want them within their borders.

East Boston voted against a resort casino proposed for Suffolk Downs, and other communities - West Springfield, Milford and Palmer - voted against similar proposals.

Background checks on proposed operators have also narrowed the field by eliminating several proposals.

Sen. Lou D'Allesandro of Manchester, prime sponsor of SB 152, which was approved by the Senate, had the backing of Hassan, but killed in the House last session - said the uncertainty in Massachusetts "enhances us dramatically."

He noted Salem, the home of Rockingham Park and one of the proposed sites, voted 80 percent in favor of accepting a casino. Other communities have voted in favor as well, he said.

"People in New Hampshire know if we do it," D'Allesandro said, "we will do it right and we will do it well just as we did with the lottery 50 years ago."

D'Allesandro will introduce a similar bill next session. Other plans are also expected.

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GETTING RID OF PAPER: Anyone who has ever attended an Executive Council meeting knows there is lots of paper.

Each of the five councilors has at least one bin of paper with the backup information for each item on the council's agenda. With generally more than 100 items every two weeks, that is a lot of paper to recycle or throw away.

On the Friday before Wednesday council meetings, state troopers deliver the bins to the councilors who than have the weekend and into the next week to peruse items.

Councilors in the past have talked about turning the paper documents into electronic ones, but little has been done, although former Gov. Craig Benson used a laptop instead of the usual binder to go through the council's agenda at the meetings.

Second District Councilor Colin Van Ostern of Concord stopped by the press room after the council's meeting Wednesday to report he no longer receives the council item information from a state trooper and instead accesses the information online before and during the meeting.